Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Monday, July 24, 2006

Can't anybody do anything right around here?

I'm actually not talking about impending World War Last -- I think I'll have to get to that however. I'm talking about the usual subject, doctoring. After a weekend away from the beat, I wake to up to read:

According to a new report by the Institute of Medicine, issued under a Congressional mandate, 1.5 million Americans are harmed or killed by medication errors every year, costing $3.5 billion just in excess medical expenses to treat the injuries, who knows how much in damage to lives and lost income. As a matter of fact, it works out to 1 error per hospitalized person per day, plus innumerably more errors that happen in outpatient settings. In other words, when the nurse shows up with the little cup of pills, it's probably about an even bet whether the right stuff is in there. (As I said in an earlier post about health care quality, they can't even get it together to give an aspirin to somebody who comes in with a heart attack? What gives here?)

The ever more popular stomach reduction surgery results in substantial complications for 4 out of 10 patients within six months, according to the Agency for Healthcare Research and Quality. And I don't just mean a tummy ache -- we're talking infections, pneumonia, respiratory failure, and uhh, a minor thing like gastric juices leaking into the body cavity. Average cost per complication? More than $36,000. If you're readmitted to the hospital? $65,000. That'll buy a life-time membership in the gym, you bet, and a lifetime membership in Jenny Craig. Of course, that's if you don't die. Doctors who make their yacht payments from doing this kind of surgery defend it, and say they're getting better at it, if they do say so themselves, but they can't actually prove that.

The simple fact is, we can and should do whatever we can to assure that health care is provided safely, effectively, respectfully, and to whoever needs it, when they need it -- BUT -- slicing, dicing and dosing the incomprehensibly complex ecology that is the human body is just something we aren't very good at yet, and quite possibly never will be. We just have too many moving parts that interact with each other too critically, mostly in ways we don't even understand. A tiny little mistake, or a wrong understanding of what we're doing in the first place, and you ain't got no red corpuscles.

We get much more value by staying healthy in the first place, in ways we understand very well how to do. Obesity is the result of a genotype that evolved in people chasing antelopes and digging up roots on the African Savannah being transplanted into a toxic environment in which we can drown in calories while barely having to lift a finger. Result? You get fat.

Concerned by flaws in previous studies, Andersen and his colleagues set out to examine the connection between children's physical activity and risk factors for heart disease and diabetes. The study looked at 1,732 9- and 15-year-olds from Denmark, Estonia, and Portugal. Physical activity was monitored for four consecutive days by strapping little machines to the youngsters' hips, which monitored accelerations in body movements.

Despite differences among the three countries where children were monitored, the benefits of physical activity were consistent. The more-active children had healthier numbers for blood pressure, cholesterol, and insulin. Because it measures activity objectively, without relying on questionnaires, Andersen's research may lead to a reconsideration of physical activity guidelines by countries and global health organizations.

``This is much stronger evidence than we've ever had before," said Nick Cavill, a research associate in the public health department at Oxford University, who wasn't involved in the study.

So turn off the TV and kick 'em out the front door. It beats the hell out of bariatric surgery.